Increasing cefazolin use for surgical prophylaxis in penicillin-allergy-labeled patients
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Published on: December 10, 2016
Kathryn A VanderVelde1,2, Sarah L Suppes1, Katherine A Gibbs3
1Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
Insights
Clarifying penicillin (PCN) allergy labels significantly increased cefazolin use in orthopedic surgery patients from 50% to 74%. Accurate allergy assessment improves appropriate antibiotic selection for surgical prophylaxis.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Quality Improvement
Background:
- Penicillin (PCN) allergy labels can lead to suboptimal antimicrobial selection for surgical prophylaxis.
- A lack of standardized processes for clarifying PCN allergy labels impacts perioperative antibiotic choices.
Purpose of the Study:
- To increase cefazolin usage in orthopedic surgery patients with PCN allergy labels from 50% to 80%.
- To implement and evaluate a quality improvement initiative for PCN allergy clarification.
Main Methods:
- A multi-phase plan-do-study-act (PDSA) quality improvement initiative was conducted.
- Methods included automated patient identification, pharmacist phone interviews, and electronic surveys for allergy clarification.
- The process focused on identifying and clarifying PCN allergy labels preoperatively in orthopedic surgery patients.
Main Results:
- Cefazolin use in PCN-allergic surgical patients increased from 50% to 74%.
- Patients with clarified PCN allergy labels were 4.21 times more likely to receive cefazolin.
- Cefazolin was recommended and administered to 90% of patients with clarified allergies, versus 59% without clarification.
Conclusions:
- Appropriate clarification and documentation of PCN allergy labels are crucial.
- This process significantly increases the appropriate use of cefazolin for surgical prophylaxis in patients with PCN allergy labels.
Objective:
Penicillin (PCN) allergy labels affect antimicrobial selection for surgical prophylaxis. We aimed to increase the percentage of cefazolin usage in patients with PCN allergy labels undergoing orthopedic surgery from 50% to 80%.
Design:
Quality improvement initiative.
Setting:
Children's Mercy Kansas City (CMKC), a freestanding children's hospital.
Patients:
Children scheduled for an orthopedic surgery (excluding spinal surgery) at CMKC who had a PCN allergy label and received a perioperative antibiotic.
Methods:
No standardized process existed to identify and clarify PCN-allergic-labeled patients preoperatively. We developed a process for patient identification combined with a pharmacist phone interview for PCN allergy clarification. In plan-do-study-act (PDSA) part 1, we implemented a computer-generated patient list. In PDSA part 2, we combined automated identification with a phone interview. In PDSA part 3, we enhanced the patient list, making it timely and concise. In PDSA part 4, we included a PCN allergy clarification electronic survey to caregivers via the electronic medical record.
Results:
Cefazolin use in PCN-allergic surgical patients increased from 50% to 74% following interventions. Patients who had their PCN allergy label clarified were 4 times more likely to receive cefazolin compared to those whose allergy labels were not clarified (OR, 4.21; 95% CI, 1.68-11.61; P = 0.003). Moreover, 90% of patients received cefazolin when their PCN allergy was clarified and cefazolin was recommended. When a PCN allergy label was not clarified, only 59% of patients received cefazolin.
Conclusions:
Appropriate clarification and documentation of PCN allergy labels increases the use of cefazolin for surgical prophylaxis.
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